How Prevalent Are Eye Health Issues Among Seniors In The United States?

Visual impairment is common in older adults, with the prevalence increasing with age [1]. The number of people with moderate/severe visual impairment worldwide is estimated to increase to 588 million by 2050 [2]. In the United States, vision impairment is a serious public health concern with more than 12 million Americans aged 40 years and older experiencing vision impairment [3]. With an aging American population, this number is expected to double by 2050 [3]. 

Addressing eye health issues among an aging population holds significant importance due to various reasons that directly impact both individuals and society as a whole.  This article will explore the prevalence of the most common eye health issues, significance in maintaining eye health, and tips for maintaining and improving eye health in seniors throughout the USA.

What Are Some Common Issues?

Some of the most common eye health issues in seniors include:

• Age-related macular degeneration: When part of the retina known as the macula begins to thin with age and develops drusen (protein deposits), age-related macular degeneration (AMD) results. AMD is a leading cause of vision loss in older adults. Approximately 1.8 million Americans aged 40 and older are affected by AMD [4]. The prevalence of AMD increases with age, particularly in individuals over the age of 60. Cases of early age-related macular degeneration are expected to double by 2050, from 9.1 million to 17.8 million for those aged 50 years or older [5]. 
• Retinopathy: The retina, which is responsible for processing light and transmitting visual information to the brain, can also undergo age-related changes. Seniors with diabetes are at risk of developing diabetic retinopathy, which can lead to vision problems. It often develops slowly, with no early warning signs. As diabetic retinopathy progresses, from mild to severe, blood vessels become blocked. If the normal flow of fluids out of the eye continues to change, pressure can build in the eyeball. This buildup can damage the nerve that carries images from your eye to your brain (optic nerve), resulting in glaucoma. Keeping your blood sugar, blood pressure, and cholesterol under control can prevent these conditions that lead to vision impairment or blindness if left untreated. Cases of diabetic retinopathy among people aged 65 or older are expected to quadruple by 2050, from 2.5 million to 9.9 million [6].
• Cataracts: Cataracts are cloudy areas in the eye's lens and are common among seniors. As the lens of the eye changes over time, proteins within the lens may clump together and cause clouding, leading to the development of cataracts. Cataracts can result in blurred or distorted vision and worsen over time. Many individuals who develop cataracts will get cataract surgery to restore their vision. More than 15 million Americans aged 65 years or older have a cataract in one or both eyes. In 2020, the estimated number of people aged 40 or older with cataracts was more than 30 million [7].
• Glaucoma: Largely a hereditary condition, glaucoma is a group of eye diseases that advances with age and can cause irreversible blindness by damaging the eye's optic nerve. It is usually caused by a buildup of fluid at the front of the eyeball. More than three million Americans are living with glaucoma, 2.7 million of whom, aged 40 and older, are affected by its most common form, open-angle glaucoma [8].
• Dry eye: Aging is a significant risk factor for dry eye. Research from the Women's Health Study and Physician's Health noted that dry eye prevalence increases in women and men every five years after the age of 50, with greater prevalence in women compared to men [9,10]. The production of tears and tear quality changes with age and is significantly impacted by comorbidities such as cardiovascular diseases, type 2 diabetes, hypertension, depression, glaucoma, and other ocular diseases, as well as medications used to manage them. Dry eye can increase eye irritation, discomfort, and vision disturbances. According to the American Journal of Ophthalmology, 4.88 million Americans over the age of 50 suffer with dry eye syndrome [11].
• Presbyopia: Beginning in the early to mid-40s, many adults may start to have problems seeing clearly at close distances, especially when reading and working on the computer. This normal change in the eyes' focusing ability, called presbyopia, results from the gradual loss of flexibility in the eye's lens. As the lens becomes less elastic, it hinders the ability to focus on close objects, leading to difficulties in reading and performing tasks at close range. Presbyopia typically becomes noticeable in the early to mid-40s and continues to worsen with age. The prevalence of presbyopia in the United States ranges from 83.0% to 88.9% of adults aged 45 years old and older [13].
• Color changes:  Many people lose their ability to clearly distinguish certain colors as they age, with loss of discrimination of saturation commonly beginning at age 50, and rapid changes noted after age 60 (14). Photoreceptor cells in the retina decline in sensitivity causing colors to become less bright and the contrast between different colors to become less noticeable. Compounded by age-related vision problems due to cataracts, glaucoma, MAD, diabetic retinopathy, floaters, and loss of eye muscle strength, many seniors may experience changes in color perception as they get older. 
• Difficulty responding to light: Aging is associated with a decrease in pupil size and a decline in the eye's ability to adapt to changes in light. This can affect the ability to see in low-light conditions, poor night vision, and photosensitivity.
• Medication induced changes: Seniors often take multiple medications, some of which may have side effects that affect eye health. Some medications can increase the risk of cataracts, retinal hemorrhages, retinal damages, double and blurred vision, dilated pupils, photosensitivity, dry eyes, and glaucoma.
• Lifestyle choices: Lifestyle choices such as smoking, UV sun exposure, poor diet, obesity, lack of exercise, inadequate sleep, high blood sugar, pressure, and cholesterol can exacerbate age-related changes and increase the risk of eye diseases.

Although these common eye health issues in seniors can change over time due to education and advancements in healthcare, the deterioration of eyesight with age is often a natural part of the aging process. Inadequately addressing these changes can have a large impact on seniors' quality of life. In fact, national studies indicate that visual impairment has widespread functional consequences with implications for families, health care systems, and society, including a higher prevalence of chronic health conditions, death, falls and injuries, depression, and social isolation.

The following reasons address the significance in maintaining eye health in seniors:

• Independence: Clear vision is crucial for maintaining independence in daily activities and hobbies. Seniors rely heavily on their eyesight for tasks such as reading, cooking, and driving contributing to confidence and autonomy. 
• Prevent Falls and Accidents: Vision impairment is a significant risk factor for falls and accidents among seniors. Regular eye check-ups can detect and address issues such as poor depth perception or difficulty in distinguishing obstacles, reducing the likelihood of accidents.
• Social Engagement: Clear vision is essential for effective communication and social interaction. Seniors with good eyesight can actively participate in social activities, fostering a sense of connection and preventing isolation. Good vision enables seniors to appreciate art, watch television, and engage in recreational activities for a fulfilling and enjoyable retirement.
• Mental Health Benefits: Visual impairment can be associated with an increased risk of depression and cognitive decline. Maintaining good eye health supports positive mental well-being and cognitive function in seniors.

What Are Some Tips for Promoting Eye Health? 

Here are some tips to help promote eye health as you get older:

• Regular Eye Exams: Prioritize and schedule regular eye check-ups with an eye care professional. Eye examinations can reveal signs of systemic conditions and address potential issues early on including cataracts, diabetic neuropathy, age-related macular degeneration (AMD), retinal issues, and glaucoma.
• Know Your Family History: Be aware of your family's eye health history, as some eye conditions have  genetic components. Discuss this with your eye care professional.
• Sun Protection: Wear sunglasses that block out harmful UV rays when you are outdoors. Prolonged exposure to UV rays can contribute to cataracts and other eye conditions.
• Quit Smoking: Smoking is linked to an increased risk of age-related macular degeneration (AMD) and other eye diseases. Quitting smoking can benefit your overall health, including your eyes.
• Manage Chronic Health Conditions: If you have conditions - like diabetes, high blood cholesterol, hypertension, or obesity - manage them effectively. These conditions have a negative impact on your eyes if not properly controlled.
• Screen Breaks: If you spend long hours working on a computer or using digital devices, follow the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds. Practicing stress-reduction techniques like this relaxation exercise and mindfulness can ease eye discomfort and stress.
• Adequate Sleep: Quality sleep is essential for overall health, including eye health. Aim for 7-9 hours of sleep per night.
• Eye Protection: Use protective eyewear when engaging in activities that could pose a risk of eye injury, such as work, sports, or home improvement projects. If you wear contact lenses, follow your eye care professional's instructions for cleaning, wearing schedule, and replacement to reduce the risk of eye infections.
• Stay Hydrated: Proper hydration is crucial for maintaining overall health, including eye health. Drink an adequate amount of water each day. Aim to have your urine looking like a light lemonade in color, versus a strong iced tea.

• Healthy Diet: Eat a balanced diet rich in fruits, vegetables, and omega-3 fatty acids. Foods like leafy greens, fish, and nuts contain nutrients beneficial for eye health. Including a high quality nutritional supplement can also be beneficial. Look for products with superior absorption, such as Healthycell's Microgel supplements.

• Maintain a Healthy Weight: Being overweight can increase your risk of developing conditions like diabetes, which can affect your eyesight.

The Importance of a Balanced Diet

While a balanced diet is the primary source of nutrients for maintaining eye health, proper supplementation may be beneficial. Of course, it is crucial to consult with your healthcare provider before starting any new supplements. Here are some supplements associated with eye health:

• Omega-3 Fatty Acids: Omega-3 Fatty Acids are known for potential benefits in reducing dry eye syndrome [15]. Sources include fish like salmon, mackerel, as well as walnuts, hemp, and flaxseeds.
• Astaxanthin, Lutein, and Zeaxanthin: These  powerful antioxidants help prevent DNA damage, protein distortion associated with cataracts, and repair cells damaged from the sun's UVA rays. More specifically, lutein and zeaxanthin support macular pigment density, color distinction capacity and recovery from light-induced stress protecting against AMD and cataracts leading to improved visual performance [16, 17]. Foods rich in astaxanthin include salmon and shrimp. Foods rich in Lutein and Zeaxanthin nutrients include kale, spinach, and other leafy greens.
• Lycopene: Lycopene is a powerful antioxidant that may be helpful for the diagnosis, severity, and therapeutic evaluation of diabetic retinopathy [18]. Tomatoes, apricots, melons, papayas, grapes, peaches, watermelons, and cranberries are rich in Lycopene.
• Vitamin A: Vitamin A is essential for maintaining the health of the cornea and other eye tissues. While vitamin A supplements are available, it's important not to exceed recommended levels, as excessive vitamin A can be harmful. For this reason, most supplements offer preformed vitamin A, such as the carotenoid lycopene.
• Vitamin C: Vitamin C is an important antioxidant helping maintain the health of blood vessels in the eyes, minimizing oxidative stress, and reducing the risk of cataract formation [19]. Citrus fruits, strawberries, and bell peppers are good dietary sources.
• Vitamin E: This is another powerful antioxidant that may help protect cells in the eyes from damage. The therapeutic role and molecular mechanisms of vitamin E's function in the retina has shown to help guard against gradual central vision loss observed in AMD [20]. Nuts, seeds, and spinach are examples of foods rich in vitamin E.
• Zinc: Zinc is an essential mineral for overall eye health and is found in high concentrations in the retina and a moderate amount of zinc supplementation helps to protect the retina.
  • When treated with a high-dose combination of vitamin C, vitamin E, beta-carotene, and zinc, researchers found that people at high risk of developing advanced stages of AMD lowered their risk by about 25 percent. (20)
• Some studies suggest that bilberry may have benefits for eye health, particularly in preventing eye fatigue [21].

In Summary

In summary, it is important to be aware that as individuals age, the risk of developing various eye health issues - such as AMD, cataracts, diabetic retinopathy, glaucoma, and dry eye syndrome -  increases. Seniors are encouraged to take proactive measures that are crucial for maintaining good eye health such as prioritizing and scheduling regular eye exams, protecting eyes from UV rays as well as recreational and work injuries, maintaining a balanced diet, staying hydrated, supplementing properly, prioritizing sleep, engaging in regular physical activity, and quitting smoking. Your vision is a precious gift that enhances the beauty of life and allows you to experience the world around you. As you gracefully navigate the aging process, it's essential to prioritize and cherish your eye health.

About the Author

Elizabeth Candela, MA, RDN, CLT, LE is a Registered Dietitian Nutritionist, Certified LEAP Therapist and Licensed Esthetician specializing in an integrative and holistic approach to address client needs. Beth utilizes various clinical methods, techniques, and comprehensive therapies, while promoting balance and harmony among her clients in all areas of life. She is the owner of B3yond Nutrition LLC and Skin Fresh in Montclair, New Jersey, and excels at helping clients reach their personal health, wellness, and beauty goals.

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